71例阿德福韦酯致低血磷性骨软化症的文献分析

Literature Analysis of 71 Cases of Hypophosphatemia Osteomalacia Induced by Adefovir Dipivoxil

目的了解低剂量阿德福韦酯致低血磷骨软化症的临床特征及预防、治疗措施。方法通过检索Pubmed、中国生物医学文献服务系统和中国知网2002年1月1日-2014年12月31日的数据,汇总有关阿德福韦酯致低磷血症的病例报道数据进行分析。结果共检索到相关文献39篇,硕士研究生毕业论文1篇,获得病例71例。患者均有乙肝病史并长期服用阿德福韦酯,出现不良反应后病程进展缓慢,以骨痛为主要临床表现,严重者出现行走障碍、肌肉萎缩等。实验室检查伴有血磷降低、血清碱性磷酸酶活性升高,影像学检查有不同程度的骨损害。患者在采取治疗措施之后,症状均得到不同程度的缓解。结论长期应用低剂量阿德福韦酯治疗慢性乙型肝炎,可能引起低磷性骨软化症,需加强临床用药监测,检查血磷等水平以及影像学检查可作为发现阿德福韦酯引发低血磷性骨损害的有效手段,如出现不良反应应及时采取有效治疗措施。

Objective To master hypophosphatemia osteomalacia＇s clinical characteristics which caused by low-dose adefovir dipivoxil, and find the prevention and treatment measures. Methods By searching the data of Pubmed, Chinese Biomedical Literature Service System and China Category （January 1st, 2002-December 31st, 2014）, the data of hypophosphatemia reported in cases caused by adefovir was summarized and analyzed. Results A total of 39 relevant documents and one graduate thesis were retrieved, including 71 cases. All of the patients have a history of hepatitis B disease and a long-term use of adefovir dipivoxil.With slow progression of adverse reactions, the main clinical manifestations are skeletal pain. Some patients experienced serious adverse reactions, such as walking disorders and muscle atrophy. Laboratory tests appeared to reduced phosphorus levels and elevated serum alkaline phosphatase activi-ty. Imaging studies showed different degrees of skeletal damage. After being taken to the treatment, the patient＇s symp-toms were eased for varying degrees. Conclusion A long-term low-dose adefovir dipivoxil treatment of chronic hep-atitis B may cause phosphorus bone softening disease. Therefore, we need to strengthen the monitoring of clinical medicine, check the phosphorus levels, and imaging examination can be used as an effective means to find hypophos-phatemia bone damage caused by adefovir. If patients had adverse reactions effective treatment should be taken time-ly.